Sudden death in young people

In August 2009, Spanish football fans the world over were stunned to learn that Daniel Jarque, the captain of Espanyola, had collapsed and died following a training session.

He was just 26. Bolton Wanderer Fabrice Muamba, was barely 23 when he collapsed suddenly during a match with Tottenham in 2012 and while he recovered, he no longer plays professional football.

While sudden death in sportsmen gets frantic media coverage, it is fortunately quite rare, with an annual frequency of one case per 50,000 people in competitive sport. However, while regular physical activity is key to healthy living, intensive sport practice has a sudden death risk that’s 2.5 times higher than in the general population. Men are at much higher risk than women.

Sudden death in young people is defined as unexpected death affecting individuals below 35 years of age during sport or less than one hour after stopping exercise or experiencing symptoms.

In 90 per cent of the cases it is related to an unidentified heart illness that had no negative impact on performance and the individuals had no warning symptoms prior to the incident. Sudden death can occur with any sport and it is thus more frequent among popular sports such as soccer, bicycling and running.

The most common cause accounting for about one quarter of all sudden deaths is an excessive thickening of the heart muscle, a condition known as hypertrophic cardiomyopathy. Unnoticed for a long time, the illness impairs heart contractions and can trigger an acute life-threatening rhythm disorder. Other predisposing heart conditions include inherited arrhythmias (rapid and irregular heartbeats), abnormal heart vessels, an undetected congenital heart defect and severe heart infection. One particular condition is called commotio cordis and is the result of a blow to the area directly over the heart at a critical time during the cycle of a heart beat causing cardiac arrest. It typically happens during baseball and American football games as well as during soccer, cricket and hockey events.

The prevention of sudden death requires regular screening of potential cardiac issues before starting any serious sport activity. In Europe, a clinical exam with an electrocardiogram (EKG) is routinely performed on sportsmen involved in competition. An EKG reveals abnormal electrical activity of the heart in 60 per cent of cases presenting the kind of silent cardiac problems that could lead to sudden death. EKG has markedly reduced the frequency of sudden death among high-level sportsmen. It is also essential to look for premonitory symptoms that could suggest a pre-existing heart illness such as past faintness episodes, chest pain, irregular heart beats or unexplained shortness of breath especially during effort. The presence of sudden death among family members below the 50 should prompt further investigations for underlying heart pathology.

People diagnosed with a sudden death prone disease should rapidly be treated. Patients with hypertrophic cardiomyopathy may benefit from an implantable cardioverter-defibrillator, a special device connected to the heart that instantly corrects any severe rhythm anomaly. People at risk of sudden death are also strongly encouraged not to engage in intense sport activity.

As sudden death syndrome is mainly related to acute cardiac arrest, immediate cardio-pulmonary resuscitation (CPR) coupled, where needed, with the use of a cardiac defibrillator, can be effective in saving lives. A recent French study reveals that successful resuscitation of a young sports victim ranges from 3 per cent in regions with poor CPR awareness to more than 40 per cent in areas where CPR awareness and training have been widely promoted. The authors conclude that CPR awareness is the most effective approach to lowering mortality among sportsmen.

CPR should be learned by all because in 80 per cent of sudden death cases involving younger people, the incident happens at home, at work or during a social or sport event. Anyone can easily perform CPR with minimal knowledge though it is best to enrol in CPR training for a few hours or at least watch CPR guidelines on the Internet.

Dr Gerard Lalande is managing director of CEO-HEALTH, which |provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at gerard.lalande@ceo-health.com.